Public Safety Committee on April 1st, 2010

[The Chair, Conservative, Garry Breitkreuz]

I'd like to bring this meeting to order.

This is the Standing Committee on Public Safety and National Security, meeting number seven. We are continuing our study of federal corrections, focusing on mental health and addictions.

We would like to welcome our witnesses for the first 45 minutes of our meeting. Ms. Oades is deputy commissioner for women. Ms. Jackson is the director general of clinical services. Ms. Thompson is regional director of health services for the prairie region. We welcome you all.

Do any of you have an opening statement?

[Jennifer Oades, Deputy Commissioner for Women, Correctional Service Canada]

We do, for five minutes each.

[The Chair, Conservative, Garry Breitkreuz]

Go ahead. Thank you.

[Jennifer Oades]

Thank you.

Good afternoon, Mr. Chair and committee members. I'm pleased to have the opportunity to appear before you today to discuss issues related to the federal population of women offenders.

In my brief opening remarks, I don't want to repeat what the previous deputy commissioner for women related to you at her appearance last November. I'll instead use my time to bring you up to date on a number of developments in the women offender file over the past five months.

First of all, I understand that the committee had the opportunity to visit a number of our institutions late last year, including Okimaw Ohci, our aboriginal healing lodge, and the regional psychiatric centre in Saskatoon, where we have the Churchill unit dedicated to the treatment of women offenders who require intensive mental health care. As such, you were able to see two very different approaches to managing our complex and diverse women offender population. If the committee members intend to visit one of the five regional facilities for women to expand your knowledge of how we manage the majority of incarcerated women offenders in our care, I would certainly be pleased to organize that for you.

The area of mental health continues to challenge us. We are committed to look for new strategies that will work for everyone: the women offenders, CSC staff, and the general public. To this end, we are working with our research branch, particularly in a project to develop a national profile of the mental health needs of women offenders. This will help us to better target our interventions and provide more effective counselling and programming to the women in our custody and in the community.

We are also examining how we manage women who pose a high risk to other offenders and CSC staff. We are currently using a system called the management protocol. It has come under criticism from the Office of the Correctional Investigator and the Canadian Association of Elizabeth Fry Societies, among others. CSC agrees that the approach is not ideal and we are currently reviewing our strategy to move away from the management protocol. We have been engaged in national consultations with various stakeholders and experts over the past few months. I expect to receive a report of their findings in the near future, which will help guide the development of an alternative and more comprehensive approach that is more in line with a fully integrated correctional plan.

As part of CSC's transformation agenda, we are now in the final stages of implementing a community framework for women offenders that will provide more support and opportunities for these offenders when they're conditionally released into the community. Over half of the federally sentenced women are in the community. This framework will affect most of the women under our care. I am exceptionally proud of this new model that will enhance the continuum of care for federally sentenced women, better support their transition into the community, and help to achieve greater public safety results for all Canadians.

I continue to work closely with my colleagues in health services, the Office of the Correctional Investigator, and our other partners to ensure we exchange information and best practices on how to effectively manage our more complex cases. To this end, I hold teleconferences and face-to-face meetings on a regular basis with the wardens of women's institutions and other officials as needed.

I would like to state in closing that I'm delighted with the challenges this new job entails. I'm very excited to be part of the group of CSC staff who work every day to improve the lives of our women offenders and help them return to the community as law-abiding citizens.

Thank you.

[Kate Jackson, Director General, Clinical Services, Correctional Service Canada]

Ms. Thompson and I are pleased to appear here before you to discuss issues related to the opiate substitution program for the offender population within the Correctional Service of Canada. The commissioner, Mr. Don Head, and the assistant commissioner of health services, Ms. Leslie MacLean, appeared before you in June 2009 and provided with you with information about the mental health strategies and initiatives within CSC. Today we will brief you on the CSC's opiate substitution program.

Injection drug use, primarily the practice of sharing injection equipment, is a major risk in the transmission of infectious diseases such as HIV and hepatitis C. Substance abuse is also a factor contributing to the commission of many crimes. Providing an opiate substitution treatment program to federal offenders helps to reduce the demand for drugs, thus improving our ability to contribute to public safety.

Research has shown that active participation in opiate substitution therapy is associated with positive release outcomes for offenders. Johnson et al. (2001) found that offenders who had participated in a methadone maintenance treatment program while incarcerated were 28% less likely to be returned to custody after release to the community than offenders who had not.

l'II provide you with the background on the program. Originally called the national methadone maintenance treatment program, it was implemented in two phases. In 1997, phase one allowed opiate-addicted offenders who were in a community methadone program prior to being sentenced to be considered for continuation of methadone treatment. Phase two, announced in May 2002, increased CSC's capacity to initiate treatment of opiate-addicted offenders requesting methadone if such treatment was deemed medically appropriate.

In December 2008 the methadone program was renamed the national opiate substitution treatment program because of the addition of an alternative opiate substitute medication called Suboxone.

When used in conjunction with cognitive programming, intensive monitoring, and support, opiate substitution has been found to be extremely helpful for opiate-dependent persons. These medications can help free the opiate-dependent person from the continuous cycle of withdrawal and opiate use. Stabilization on opiate substitutes allows offenders to concentrate in school and participate in programming and work, thus increasing their ability to actively engage in their correctional plan.

Prior to initiation of treatment, a detailed health and mental health assessment is conducted with each offender to determine whether the offender meets the necessary criteria, such as whether the offender has received from a physician a diagnosis of dependency to opiates. Congruent with community practice, the assessment process includes a review of the rules of the program outlined in a treatment agreement between the offender and care providers, outlining what each commits to, including the requirement for ongoing monitoring.

In 2009-10 the cost of CSC's opiate substitution program was over $12 million. As of January 2010, there were 701 offenders on opiate substitution therapy across the country, of whom 55 were women offenders. Due to offender flow-through, over 1,000 offenders are managed on the program by CSC every year. CSC's opiate substitution program is managed in a multi-disciplinary team approach, with involvement from case management, programs, and health services, and in accordance with national guidelines.

In 2009, of the 512 offenders who were admitted to the CSC opiate substitution program from the community, most were received from provincial correctional facilities. The majority of these facilities provide treatment to offenders who are already on methadone in the community. For those offenders entering CSC already on methadone, CSC maintains their treatment while they undergo assessment to ensure they meet the program criteria.

To ensure safety and security, offenders are observed for 20 minutes after taking their methadone, which reduces the risk that offenders will divert the medications. A nurse provides each dose directly to the offender and watches the offender swallow the medication. The offenders are observed for 20 minutes to ensure that most of the medication is absorbed.

All offenders in treatment are expected to participate in regular substance abuse programs, which are specifically geared to opiate dependence and delivered by trained program delivery officers. An offender's progress is monitored and reviewed on a regular basis through meetings with their individualized intervention team.

The opiate substitution program is subject to regular medical and institutional reviews to provide early identification of areas of concern, tailor educational training sessions for staff, and modify procedural policies.

Extensive preparation is done for any offender being released to the community on opiate substitution to ensure the transition is smooth and continuity of care is maintained. This process starts at the onset of initiation into the program. The availability of a community provider is reviewed and confirmed six months prior to release.

Thank you.

[The Chair, Conservative, Garry Breitkreuz]

Ms. Thompson, go ahead.

[Heather Thompson, Regional Director, Health Services, Prairie Region, Correctional Service Canada]

I have no opening comments.

[The Chair, Conservative, Garry Breitkreuz]

Okay.

Then we'll go over to the official opposition for a seven-minute round of questions and comments.

Mr. Holland, please.

[Mark Holland, Liberal, Ajax—Pickering, ON]

Thanks, Mr. Chair.

Mr Chair, I'm going to start the meeting actually before my time, if I could, with just a point of order.

I think it's important that we have disagreements in this committee about whether or not one another's policies are better than another policy, but I think inferring motive on another member is very problematic. As members of this committee, Ms. Glover and I both did a forum, and it was stated that the reason why we have the policies we do is because we have a conflict of interest. We support criminals because they vote Liberal is what was said.

[Shelly Glover, Conservative, Saint Boniface, MB]

Nonsense.

[Mark Holland, Liberal, Ajax—Pickering, ON]

It was said. It's part of the record.

Let me say this, Ms. Glover: you're a good person. I do not question your motives. I disagree with policies that you may advocate, but I never question your motives. The idea that somehow I care less about my children or my family than you do yours does a tremendous disservice to this process.

I would simply ask that Ms. Glover correct the record on that. It was an unfortunate comment, and I would ask her to correct the record. The exact words were that the Liberals have a vested interest because prisoners vote for Liberals. This is what you said.

I just think that this is the sort of discussion that infers motive on other members and I think is very disappointing. I would ask you, Ms. Glover, to retract the statement.

[The Chair, Conservative, Garry Breitkreuz]

I'm not sure that's a point of order, Mr. Holland. I don't see how that's a point of order.

Go ahead and ask your question.

[Mark Holland, Liberal, Ajax—Pickering, ON]

It was for me.

[The Chair, Conservative, Garry Breitkreuz]

Go ahead and ask your question.

[Mark Holland, Liberal, Ajax—Pickering, ON]

To the witnesses, thank you for appearing before committee today. I'm greatly appreciative of you taking the time.

One of the things that concerns me, obviously, is that more than 80% of our inmates are facing addictions issues. So they're coming into our facilities often because they're facing addictions problems. The chief way of dealing with addictions that has been introduced by this government has been to try to shut down access. There's been an enormous amount of money spent on that. Now, we know that the drug usage in prisons in 2005 was 12% in random urine test samplings, and in 2008, which is the last date we have data, it is now up to 13.2%.

You know how much has been spent on these efforts to clamp down, and given the fact that drug use in prisons has actually gone up in this period of time, how would you assess the efficacy of that spending?

[Kate Jackson]

I think what we can say is that we have evidence to show that the substance abuse programs that offenders are involved in generally result in positive results. For the offender, they're better able to participate in programs and they have a better release—

[Mark Holland, Liberal, Ajax—Pickering, ON]

Sorry, I don't mean to interrupt, but I think you misunderstood the question.

I'm very much in favour of the programs that help rehabilitate inmates. I'm talking about the principal money. I'm wondering if you know the figure of how much has gone into trying to stop and clamp down drugs coming into the system. There's been a tremendous amount of money spent to stop drugs coming into the system, and yet drug usage rates over the last number of years have actually increased at the same time. So I'm asking for your feeling on the efficacy of that spending.

[Jennifer Oades]

I don't have the numbers of how much, but we can get them for you. There has been a huge effort over the last few years in terms of drug interdiction, new processes, including drug dogs, etc. So we can provide you with those numbers. We can probably provide you with updated.... You're suggesting that the urinalysis reports are indicating that they still show a high level of offenders using drugs?

[Mark Holland, Liberal, Ajax—Pickering, ON]

Right.

[Jennifer Oades]

I don't know that it is still the case, but we will look into it and get you that material.

[Mark Holland, Liberal, Ajax—Pickering, ON]

Thank you. Another thing that is of great concern and that witnesses will be discussing later is the prevalence of both HIV/AIDS and hepatitis C, and infectious diseases generally within the prison system. As an example, we know that some 30% of the prison population has hepatitis C and that HIV rates are actually ten times higher than in the average population.

Often what people don't think about is that given that 91% of inmates will eventually be released into society, this poses not only a health threat inside the prisons but a serious public health threat outside the prisons. So given the fact that we have witnesses coming here later on today to say that the rate of infectious disease is accelerating, not slowing down, what specifically are you doing to stop the spread of infectious diseases in our prisons?

[Kate Jackson]

I think there are a number of health promotion initiatives within the prisons to help reduce the spread of infection. We do health education for inmates. One of the objectives of the methadone program is to help reduce the spread of infection, to reduce the demand for injected drug use. We also provide some preventive devices such condoms, dental dams, and immunization programs, which also help reduce the rate of infection.

[Mark Holland, Liberal, Ajax—Pickering, ON]

How well resourced do you feel those programs are, and how would you assess the efficacy of those programs, particularly in light of the fact that we are seeing infectious disease rates continue to climb in our prisons and be at such a staggeringly high level relative to the rest of the population?

[Kate Jackson]

Right, and some of that is not just the spread within the prison but the population that's coming in, their behaviour. Generally speaking, the risk behaviours of the offender population is much greater than the risk behaviours of the population at large prior to admission to the institutions. We're continuing to monitor the efficacy of the different programs we provide in the prisons to try to see what the outcomes are and to try to improve those programs based on the results and also based on the efficacy of programs outside the prison environment.

[Mark Holland, Liberal, Ajax—Pickering, ON]

Mrs. Oades, on the issue of mental health specifically, we know that female inmates are more prone than others to face mental health issues. One of the things police officers are telling us is they don't have facilities for the mentally ill and the prisons end up becoming a repository, a de facto mental institution that is not properly resourced. Given the fact that now more than 20% of women are facing serious mental health issues, and there are suggestions it's even higher because of lack of proper diagnosis, can you assess the efficacy of efforts to this point to find other avenues to help women who have mental illness to not end up in prison? What do you feel has to be done to bring down those dangerous numbers?